膀胱出口梗阻指数在评估良性前列腺增生症膀胱出口梗阻中的应用

目的 探讨膀胱出口梗阻指数(BOON)在评估前列腺增生患者膀胱出口梗阻(BOO)中的意义.方法 对临床有下尿路症状,怀疑存在因前列腺增生症(BPH)导致膀胱出口梗阻的76例患者,测定前列腺体积(经直肠),最大自由尿流率(Qmax)和平均排尿量,通过公式计算BOON=前列腺体积(cm3)-3×Qmax(ml/s)-0.2×平均排尿量(ml).同时对患者进行压力.流率测定,计算AG值和Schafer梗阻级别,与BOON对照,分析利用BOON评估膀胱出口梗阻的准确性.结果 将本组患者年龄、前列腺体积、最大尿流率、残余尿量及BOON值,以AG作为因变量,同AG进行多元线性回归分析.整体回归方程中R=0.542(P=0.000),其中BOON值同AG值相关性最强(P=0.000).18例BOON值>-10,此时利用BOON判断BOO的敏感性为31%,特异性为100%,取BOON>-20时,敏感性为42.4%,特异性为88.2%;取BOON>-30时,敏感性为66.1%,特异性为82.4%;而取BOON>-40时,敏感性为77.9%,其特异性为64.7%.取BOON值-30作为分界点,在不明显降低特异性的同时,能够更敏感的判断BOO,BOON数值越大,利用BOON判断膀胱出口梗阻的特异性越高.结论 通过测定前列腺体积,最大自由尿流率(Qmax)和平均排尿量计算膀胱出口梗阻指数,取BOON>-30为分界点,是预测前列腺增生症是否存在膀胱出口梗阻的一种简易、无创方法,具有较好的特异性和敏感性.

Applying bladder outlet obstruction number to predict bladder outlet obstruction of benign prostatic hyperplasia

Objective Applying bladder outlet obstruction number(BOON) to predict bladder outlet obstruction (BOO) of benign prostatic hyperplasia(BPH). Methods Seventy-six male who were suspected to suffer from BOO due to BPH with lower urinary tract symptoms were evaluate& The data included prostate volume (by transreetal prostate ultrasound), maximum urine flow rate (Qmax)and mean voided volume to calculate the BOON by simple algorithm: prostate volume (cm3)-3×Qmax (ml/s) -0.2×mean voided volume(ml). Pressure-flow study was also pedormed on each patient to get AG number and Schafer obstruction grade. Correlation between traditional parameters, BOON and AG number was calculated to evaluate the price of using BOON to predict BOO. Results Parameters such as age, prostate volume, maximum urine flow rate,residual urine and BOON were used as independent and AG was used as dependent to calculated the multiple linear regression. Data expressed the entire regression equation's R =0.542 (P= 0. 000), and result showed BOON had the strongest relationship with AG (P =O. 000). Eighteen patients' BOON number were greater than - 10, by AG number and Sehafer obstruction grade proving, all these patients were suffered from BOO, the sensitivity and the specificity of judgiag BOO by BOON were 31% and 100% respectively. While take BOON as-20, the sensitivity and the specificity were 42. 4% and 88. 2%, when take BOON as -30, the sensitivity and the specificity were 66. 1% and 82. 4%, respectively. Fifty- two persons' BOON were greater than -40, 46 patients suffered from BOO, the sensitivity and the specificity were 77.9% and 64. 7%, the specificity and the opportunity of having BOO decreased significantly. The data showed that: taking BOON = - 30 as critical point can predict BOO with higher sensitivity and specificity, greater BOON means greater possibility of BOO. Conclusions Using BOON which is deduced from prostate volume, maximum urine flow rate and mean voided volume, the point -30 as critical point, can predict the probability of BOO with higher sensitivity and specificity.